Uchida-Kobayashi Sawako, Kageyama Ken, Takemura Shigekazu, Matsumoto Kazuhiro, Odagiri Naoshi, Jogo Atsushi, Kotani Kohei, Kozuka Ritsuzo, Motoyama Hiroyuki, Kawamura Etsushi, Hagihara Atsushi, Yamamoto Akira, Fujii Hideki, Tanaka Shogo, Enomoto Masaru, Tamori Akihiro, Miki Yukio, Kubo Shoji, Kawada Norifumi
Department of Hepatology, Graduate School of Medicine Osaka Metropolitan University Osaka Japan.
Department of Premier Preventive Medicine, Graduate School of Medicine Osaka Metropolitan University Osaka Japan.
JGH Open. 2022 Sep 21;6(11):754-762. doi: 10.1002/jgh3.12819. eCollection 2022 Nov.
We evaluated the efficacy of rechallenge transcatheter arterial chemoembolization (TACE) after lenvatinib (LEN) treatment in patients with previous TACE failure/refractoriness.
We enrolled 63 consecutive patients with a history of TACE failure/refractoriness prior to LEN treatment as a first-line systemic therapy. We reviewed the clinical backgrounds and courses of the patients.
In total, 25 patients underwent rechallenge TACE after LEN due to LEN-refractoriness (17 cases) or intolerance (8 cases). A complete or partial response was obtained for 13 (65.0%) of the 20 patients whose therapeutic effects were determined. The survival rate of patients who underwent rechallenge TACE was significantly higher than that of patients who did not undergo rechallenge TACE (median survival time, not reached 403 days, = 0.015). Rechallenge TACE significantly reduced the risk of death in univariate (hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.08-0.69, = 0.008) and multivariate analyses (HR 0.26, 95% CI 0.08-0.80, = 0.019). If complete or partial response was obtained by rechallenge TACE, the median survival time of these patients was significantly longer than those of the progressive disease (PD) group ( = 0.05), and the median survival time of the PD group after rechallenge TACE was not different from that of the group who did not undergo rechallenge TACE ( = 0.36). We did not observe a decrease in the ALBI score after TACE.
Rechallenge TACE after LEN is an effective treatment that may result in a favorable prognosis.
我们评估了在先前经动脉化疗栓塞术（TACE）治疗失败/难治的患者中，乐伐替尼（LEN）治疗后再次进行经动脉化疗栓塞术（TACE）的疗效。
我们纳入了63例连续的患者，这些患者在接受LEN作为一线全身治疗之前有TACE治疗失败/难治的病史。我们回顾了患者的临床背景和病程。
总共有25例患者在LEN治疗后因LEN难治（17例）或不耐受（8例）而接受了再次TACE治疗。在20例确定了治疗效果的患者中，13例（65.0%）获得了完全或部分缓解。接受再次TACE治疗的患者的生存率显著高于未接受再次TACE治疗的患者（中位生存时间，未达到对403天，P = 0.015）。再次TACE在单因素分析（风险比[HR] 0.24，95%置信区间[CI] 0.08 - 0.69，P = 0.008）和多因素分析（HR 0.26，95% CI 0.08 - 0.80，P = 0.019）中均显著降低了死亡风险。如果再次TACE获得了完全或部分缓解，这些患者的中位生存时间显著长于疾病进展（PD）组（P = 0.05），并且再次TACE后PD组的中位生存时间与未接受再次TACE治疗的组没有差异（P = 0.36）。我们未观察到TACE后白蛋白-胆红素（ALBI）评分下降。
LEN治疗后再次TACE是一种有效的治疗方法，可能会带来良好的预后。
